Managing Liquids in a Dysphagia Diet

Dysphagia is when a person has trouble swallowing normally. A dysphagia diet is a way of eating and drinking that is safer for a person who has trouble swallowing. It helps to prevent aspiration. On a dysphagia diet, only certain kinds of liquids are safe to drink.

Understanding dysphagia and aspiration

Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. When a person has dysphagia, aspiration is always a risk. You may be at risk for aspiration from dysphagia if you have any of these health conditions:

  • Stroke

  • Severe dental problems

  • Conditions that lead to less saliva, such as Sjogren’s syndrome

  • Mouth sores     

  • Parkinson disease or other neurologic conditions

  • Muscular dystrophies

  • Blockage in the esophagus, such as a growth from cancer

  • History of radiation or surgery for throat cancer

Types of liquids in a dysphagia diet

A person with dysphagia may aspirate thin liquids more easily. Because of this, some people with dysphagia need to avoid certain liquids. Or liquids need to be made thicker.

Liquids come in different types. Some are thin and flow quickly. Others are thicker and flow more slowly. Thicker liquids that flow slowly are easier to swallow. The liquids that may work best depend on how serious your dysphagia is. Drinking the right types of liquids will reduce your risk for aspiration.

Your dysphagia may be treated by a speech language pathologist (SLP). Talk with your SLP about which types of liquids you are allowed. From thin to thick, the types are:

  • Thin. These are watery liquids such as juice, tea, milk, soda, beer, and broth.

  • Nectar-like. These are slightly thicker liquids, such as vegetable juices and thin milkshakes.

  • Honey-like. These liquids are like honey at room temperature.

  • Spoon-thick. These are pudding-like liquids that are too thick to go through a straw.

Ways to manage your liquids

You can manage your liquids by making thin liquids thicker. This is done by adding a flavorless gel, gum, powder, or another liquid to it. These are called thickeners. By adding a thickener, you can bring any liquid to the right level of thickness that you need. You may be able to buy thickeners at a pharmacy. Or you may buy them in medical supply stores. Thickeners have directions on the package that show how to use them. You can also buy pre-thickened liquids. These may be more expensive. But you do not need to prepare them first. Talk with your SLP if you have any questions about preparing your liquids.

Many people do not enjoy drinking liquids with added thickeners. These thickeners may lessen flavor, make you feel full quickly, or form lumps. Some people prefer the taste of one thickener over another. Other people may prefer pre-made products. Try different types to find the thickened liquids that you most enjoy.

When it’s time to drink

While drinking, it may help to sit upright. You may need support pillows to get into the best position. It may also help to have few distractions while drinking. Changing between solid food and liquids may also help your swallowing. Stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration.

Keep watch for symptoms of aspiration such as:

  • Coughing or wheezing during or right after eating

  • Too much saliva

  • Shortness of breath or tiredness while eating

  • A wet-sounding voice during or after eating or drinking

  • Fever 30 to 60 minutes after eating

While you’re on a dysphagia diet

While on a dysphagia diet, you may have trouble getting enough fluid. This can cause dehydration, which can lead to serious health problems. Talk with your healthcare team about how you can help prevent this.  In some cases, drinking thicker liquids may make some of your medicines work less well. Because of this, you may need some of your medicines changed for a while.

Many people with dysphagia also need to be careful about the foods they eat. Talk with your SLP about the foods that are allowed on your dysphagia diet.

Also make sure to:

  • Follow all instructions about what food and drink you can have.

  • Do swallowing exercises as advised.

  • Do not change your food or liquids, even if your swallowing gets better. Talk with your healthcare provider first.

  • Tell all healthcare providers and caregivers that you are on a dysphagia diet. Explain which foods and liquids you can and can’t have.

Follow-up testing

Your healthcare team will keep track of how well you are swallowing. You may need follow-up tests such as a fiberoptic endoscopic evaluation of swallowing (FEES) test. If your swallowing gets better, you may be able to drink thinner liquids over time. In time, you may be able to drink liquids of all kinds. If your swallowing gets worse, you may need to drink only thicker liquids for a time.

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

  • Your trouble swallowing gets worse

  • Symptoms of dehydration

  • Shortness of breath or tiredness while eating

  • A wet-sounding voice after eating or drinking